North Carolina Residents

State and Local Government

Providers of MH/DD/SA Services

Statistics and Publications

Provider Endorsement Information

General Information about Provider Endorsement

Forms | Checksheets

 

Implementation Update #45	Accreditation Update, Community Support 25% Requirement, Community Support Suspension, Service Definition Workgroup Update, CAP-MR/DD Update, PCP Change for Court Involved Consumers, Staffing Announcements from DMA, Reporting Provider Changes, Common Billing Errors, New Denial Code on EOB, NEA Forms
Policies 12/08	Policy and Procedure for the Review, Approval and Follow-Up of Plan(s) of Correction (POC)Revision date: 12/10/2008
Policies 12/07	Revised Endorsement Policy 12/03/07 | Plan of Correction 12/03/07 | Notification of Endorsement Action 9/08
Implementation Update #33	Full Endorsement of Providers of MH/DD/SA Services | Revised Policy for 9-7-07   | Endorsement/PPR/Audit/SB163, indicating the expected route of completion of the full endorsement process as related to Post Payment Clinical Reviews, SB163 Monitoring and Community Support Audits. (Flow Chart)
Implementation Update #30 (6/14/07)	Full Endorsement of Providers of Community Intervention Services
Implementation Update #26 (4/12/07)	End Transition Period for Provider Endorsement Types of Business Entities | Guidance for Implementing Core Rules
Enhanced Services Implementation Update #20 (12-11-06)	(12/11/06) 12/18/06 Enrollment in Child Residential Services Checksheet Information
Communication Bulletin #055 (6/06)	New Endorsement Phases, Policy Amendment
Communication Bulletin #047 (8/05)	Provider endorsement transition plan and the various "windows" or endorsement schedules.
Communication Bulletin #044 (7/05)	Final policy on provider endorsement: Policy and Procedures for Endorsement of Providers of Medicaid Reimbursable MH/DD/SA Services
LME Operations Manual 6/05
Communication Bulletin #037 (4/05)	Draft Endorsement Policy
The forms below have been re-arranged to show the newest documents at the top.
FORMS
Administrative	CSS Provider Contested Case Form (09/08) Notification of Endorsement Action (NEA Form Letter) (09/08) Additions and Changes to NEA Form Letter (9/28/07) MOA between LME and Provider (5/15/06) Notification of Endorsement Action (NEA Form Letter) (7/31/07) Additions and Changes to NEA Form Letter (7/31/07) LME Endorsement Statistics Weekly Report (7/31/07) Provider Endorsement Appeal Policy (4/6/06) Core Rules Self Study (8/05) Notification of State of Application Information (7/05) NOT IN USE - Provider Endorsement Application (PDF)  (Word)
CHECKSHEETS
Adult Mental Health	Psychosocial Rehabilitation (PSR) (10/07) Checksheet | Instructions | Daily Note Guide
Adult Mental Health/ Substance Abuse	Community Support Team (10/07) Checksheet | Instructions Facility Based Crisis Services (10/07) Checksheet | Instructions
All	Diagnostic Assessment (10/07) Checksheet | Instructions Mobile Crisis (10/07) Checksheet | Instructions
Child Mental Health	Child Residential Level II Checksheet (10/07) Child Residential Level III Checksheet (10/07) Child Residential Level IV Checksheet (8/06) Multi-Systemic Therapy (MST) (10/07) Checksheet | Instructions Day Treatment (10/07) Checksheet | Instructions
Child Mental Health/ Substance Abuse	Intensive In-Home (10/07) Checksheet | Instructions
Mental Health	Partial Hospitalization (10/07) Checksheet | Instructions
Mental Health/ Substance Abuse	Assertive Community Treatment Team (ACTT) (10/07) Checksheet | Instructions Community Support: Adult (10/07) Checksheet | Instructions Community Support: Child (10/07) Checksheet | Instructions
MR/DD	Targeted Case Management (12/05) Checksheet
Substance Abuse	Detox Services: Ambulatory (10/07) Checksheet | Instructions Detox Services: Medically Supervised/ADATC (10/07) Checksheet | Instructions Detox Services: Non-hospital Medical (10/07) Checksheet | Instructions Opioid Treatment (10/07) Checksheet | Instructions Substance Abuse Comprehensive Outpatient Treatment (SACOT) (10/07) Checklist | Instructions Substance Abuse Intensive Outpatient (SAIOP) (10/07) Checksheet | Instructions Substance Abuse Medically Monitored Community Residential (10/07) Checksheet | Instructions Substance Abuse Non-Medical Community Residential (10/07) Checksheet | Instructions
CAP-MR/DD Waiver Services
CHECKSHEETS
	Crisis Respite Checksheet | Instructions (12/08) Adult Day Health Checksheet | Instructions (11/08) Crisis Services Checksheet | Instructions (12/08) Day Supports Checksheet | Instructions (11/08) Home and Community Supports Checksheet | Instructions (11/08) Home Supports Checksheet | Instructions (11/08) Personal Care Services Checksheet| Instructions (11/08) Residential Supports Checksheet | Instructions (11/08) Respite Care Checksheet | Instructions (11/08) Specialized Consultative Services Checksheet|Instructions (11/08) Supported Employment Checksheet |Instructions (11/08) Vocational Support Checksheet | Instructions (11/08)
CAP-MR/DD Staff Training and Competencies
	CAP-MR/DD Elements for Incident/Accident and Other Reportable Events (11/08) Elements for Core Values | Core Values (11/08) Elements for Overview of Developmental Disabilities (11/08) Elements for Interaction and Communication Competencies (11/08) Elements for Participant Rights (11/08) Elements for Person Centered Thinking (11/08) Elements for Role/Purpose/Philosophy of Services (11/08) Elements for Service and Documentation (11/08) CAP Monitoring Procedure and the Acknowledgment Letter: For use by LME(s) and existing providers of the 8 modified services and existing providers who signed the Attestation Letter for the Home Supports. CAP Acknowledgment of Compliance | (11/17/08) CAP LME Monitoring Procedure (11/17/08)